Provider Demographics
NPI:1518237411
Name:CHAMBERLAIN, CHARLEY (RPH)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1512
Mailing Address - Country:US
Mailing Address - Phone:509-665-7539
Mailing Address - Fax:509-665-3180
Practice Address - Street 1:1050 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1512
Practice Address - Country:US
Practice Address - Phone:509-665-7539
Practice Address - Fax:509-665-3180
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH0001103183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist